Abstract

Background

Due to the restrictive nature of a gluten-free diet, celiac patients are looking for
alternative therapies. While drug-development programs include gluten challenges,
knowledge regarding the duration of gluten challenge and gluten dosage is insufficient.

We challenged adult celiac patients with gluten with a view to assessing the amount
needed to cause some small-bowel mucosal deterioration.

Results

Both moderate and low amounts of gluten induced small-bowel morphological damage in
67% of celiac patients. Moderate gluten doses also triggered mucosal inflammation
and more gastrointestinal symptoms leading to premature withdrawals in seven cases.
In 22% of those who developed significant small- intestinal damage, symptoms remained
absent. Celiac antibodies seroconverted in 43% of the patients.

Conclusions

Low amounts of gluten can also cause significant mucosal deterioration in the majority
of the patients. As there are always some celiac disease patients who will not respond
within these conditions, sample sizes must be sufficiently large to attain to statistical
power in analysis.